Provider Demographics
NPI:1235859653
Name:CZERNIAK, SYLVIA
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:
Last Name:CZERNIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 RICHMOND RD APT C
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1615
Mailing Address - Country:US
Mailing Address - Phone:262-394-3363
Mailing Address - Fax:
Practice Address - Street 1:203 RICHMOND RD APT C
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1615
Practice Address - Country:US
Practice Address - Phone:262-394-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer